Healthcare Provider Details

I. General information

NPI: 1760250294
Provider Name (Legal Business Name): EKHO AUDIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 NW YORK DR STE 102
BEND OR
97703-1054
US

IV. Provider business mailing address

780 NW YORK DR STE 102
BEND OR
97703-1054
US

V. Phone/Fax

Practice location:
  • Phone: 541-280-7548
  • Fax: 541-904-8378
Mailing address:
  • Phone: 541-280-7548
  • Fax: 541-904-8378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLY MANKIN ANDERSON
Title or Position: AUDIOLOGIST
Credential: AUD
Phone: 541-280-7548